Kubota K, Bandai Y, Sano K, Teruya M, Ishizaki Y, Makuuchi M
Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Surgery. 1995 Sep;118(3):555-61. doi: 10.1016/s0039-6060(05)80373-3.
The usefulness of intraoperative ultrasonography during laparoscopic cholecystectomy (LC) has yet to be evaluated fully.
In 50 patients who underwent LC, the intraoperative ultrasonography findings were compared with those of preoperative ultrasonography, intraoperative cholangiography, and histology, and then its usefulness for examining anatomic relationships in the hepatoduodenal ligament, detecting bile duct stones, diagnosing gallbladder polyps and abnormally thickened walls, and determining the propriety of LC was appraised.
The preoperative ultrasonography diagnoses were gallstones in 38 patients, polyps in 10, and cancer and adenomyomatosis in one each. In four patients endoscopic retrograde cholangiography showed bile duct stones. In all 50 patients intraoperative ultrasonography was useful for examining the anatomic relationships between the bile duct and vessels, such as the portal vein and hepatic artery, and showing the presence or absence of bile duct stones. On the basis of the intraoperative ultrasonography findings, gallstones were diagnosed in 38 patients, in five of whom bile duct stones were shown clearly, cholesterol polyps in eight, early-stage cancer or adenoma in two, and adenomyomatosis in two, and subsequently LC was performed. Histologic diagnoses of cholesterol polyps were made in eight of ten patients with polyps, and intramucosal cancer and an inflammatory polyp in one each. In one patient with a preoperative diagnosis of cancer the apparently elevated flat lesion was found to be partial thickening of the gallbladder wall, which was diagnosed as adenomyomatosis, and LC was chosen as the operative procedure.
Intraoperative ultrasonography during LC is useful for detecting bile duct stones, diagnosing gallbladder polyps and abnormally thickened walls, and deciding whether LC is adequate for resection of the gallbladder.
腹腔镜胆囊切除术（LC）中术中超声检查的实用性尚未得到充分评估。
对50例行LC的患者，将术中超声检查结果与术前超声检查、术中胆管造影及组织学检查结果进行比较，进而评估其在检查肝十二指肠韧带解剖关系、检测胆管结石、诊断胆囊息肉及胆囊壁异常增厚以及确定LC手术的适宜性方面的实用性。
术前超声检查诊断为胆结石38例，息肉10例，癌症和腺肌病各1例。4例患者经内镜逆行胆管造影显示有胆管结石。在所有50例患者中，术中超声检查有助于检查胆管与血管（如门静脉和肝动脉）之间的解剖关系，并显示有无胆管结石。根据术中超声检查结果，诊断为胆结石38例，其中5例清晰显示有胆管结石，胆固醇息肉8例，早期癌症或腺瘤2例，腺肌病2例，随后进行了LC手术。10例息肉患者中有8例经组织学诊断为胆固醇息肉，1例为黏膜内癌，1例为炎性息肉。1例术前诊断为癌症的患者，其明显隆起的扁平病变被发现是胆囊壁局部增厚，诊断为腺肌病，选择LC作为手术方式。
LC术中超声检查有助于检测胆管结石、诊断胆囊息肉及胆囊壁异常增厚，并决定LC是否适合胆囊切除。
